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WO2012057865A1 - Ajustement automatique des paramètres de détection de l'arythmie - Google Patents

Ajustement automatique des paramètres de détection de l'arythmie Download PDF

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Publication number
WO2012057865A1
WO2012057865A1 PCT/US2011/034474 US2011034474W WO2012057865A1 WO 2012057865 A1 WO2012057865 A1 WO 2012057865A1 US 2011034474 W US2011034474 W US 2011034474W WO 2012057865 A1 WO2012057865 A1 WO 2012057865A1
Authority
WO
WIPO (PCT)
Prior art keywords
detection
detection parameters
adjusted
parameters
patient
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/US2011/034474
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English (en)
Other versions
WO2012057865A8 (fr
Inventor
Xiaohong Zhou
Robert Stadler
Bruce D. Gunderson
Walter H. Olson
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Medtronic Inc
Original Assignee
Medtronic Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Medtronic Inc filed Critical Medtronic Inc
Publication of WO2012057865A1 publication Critical patent/WO2012057865A1/fr
Publication of WO2012057865A8 publication Critical patent/WO2012057865A8/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/362—Heart stimulators
    • A61N1/37—Monitoring; Protecting
    • A61N1/3706—Pacemaker parameters
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/316—Modalities, i.e. specific diagnostic methods
    • A61B5/318—Heart-related electrical modalities, e.g. electrocardiography [ECG]
    • A61B5/346—Analysis of electrocardiograms
    • A61B5/349—Detecting specific parameters of the electrocardiograph cycle
    • A61B5/361—Detecting fibrillation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/316—Modalities, i.e. specific diagnostic methods
    • A61B5/318—Heart-related electrical modalities, e.g. electrocardiography [ECG]
    • A61B5/346—Analysis of electrocardiograms
    • A61B5/349—Detecting specific parameters of the electrocardiograph cycle
    • A61B5/363—Detecting tachycardia or bradycardia
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/48—Other medical applications
    • A61B5/4836—Diagnosis combined with treatment in closed-loop systems or methods
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/362—Heart stimulators
    • A61N1/3621—Heart stimulators for treating or preventing abnormally high heart rate

Definitions

  • Detection of arrhythmias may be determined, for example, by comparing one or more monitored physiological parameters of a patient (e.g., heart-related physiological parameters) to one or more predetermined, programmable detection parameters.
  • the monitored physiological parameters may include intervals between monitored electrical cardiac events in the atria (e.g., P-waves) and/or ventricles (e.g., R- waves).
  • the intervals between two monitored electrical cardiac events (such as R-R intervals or P-P intervals) may be compared to detection parameters (e.g., detection intervals).
  • monitored R-R intervals may be compared to one or more detection intervals, e.g., VT detection interval, a fast VT detection interval, a VF detection interval, etc.
  • a detection interval may be defined as a threshold value, which may be compared to (e.g., less than or greater than) the monitored intervals (e.g., R-R intervals) for various arrhythmia detections.
  • FIG. 3 is a block diagram of the IMD of FIG. 1.
  • FIG. 4 is a flow chart of an exemplary method for use in delivering therapy to a patient's heart, e.g., using the IMD of FIGS. 1-3.
  • FIG. 5 is a flow chart of an exemplary method for use in conjunction with the method of FIG. 4.
  • the leads 18, 20, 22 extend into the heart 12 of the patient 14 to sense electrical activity of the heart 12 and/or deliver electrical stimulation to the heart 12.
  • the right ventricular (RV) lead 18 extends through one or more veins (not shown), the superior vena cava (not shown), the right atrium 26, and into the right ventricle 28.
  • the left ventricular (LV) coronary sinus lead 20 extends through one or more veins, the vena cava, the right atrium 26, and into the coronary sinus 30 to a region adjacent to the free wall of the left ventricle 32 of the heart 12.
  • the right atrial (RA) lead 22 extends through one or more veins, the vena cava, and into the right atrium 26 of the heart 12.
  • the IMD 16 and the programmer 24 may communicate via wireless
  • the IMD 16 may include one or more housing electrodes, such as housing electrode 58, which may be formed integrally with an outer surface of a housing 60 (e.g., hermetically-sealed housing) of the IMD 16 or otherwise coupled to the housing 60.
  • housing electrode 58 may be formed integrally with an outer surface of a housing 60 (e.g., hermetically-sealed housing) of the IMD 16 or otherwise coupled to the housing 60.
  • the processor 80 of the control module 81 may control the therapy delivery module 84 to deliver electrical pulses with delays, timings, amplitudes, pulse widths, frequency, and/or electrode polarities specified by the one or more therapy programs (e.g., CRT programs, ATP programs, defibrillation/cardio version programs, etc.).
  • the therapy programs e.g., CRT programs, ATP programs, defibrillation/cardio version programs, etc.
  • the sensing module 86 may further include an atrial sense amplifier and a ventricular sense amplifier, which may take the form of automatic gain controlled amplifiers with adjustable sensing thresholds.
  • Exemplary sense amplifiers are disclosed in U.S. Pat. No. 5,117,824 to Keimel et al.
  • a signal representative of an atrial electrical event is generated and transmitted to the control module 81, and likewise, whenever a signal is received by the ventricular sense amplifier that exceeds a ventricular sensing threshold, a signal representative of a ventricular electrical event is generated and transmitted to the control module.
  • ATP therapy may be delivered to the patient in
  • the telemetry module 88 of the control module 81 may include any suitable
  • a VT and/or VF may be detected (block 204) using one or more monitored
  • the method 200 may automatically raise the threshold for detection of VT/VF to avoid false positive indications of sustained VT/VF when a non-sustained VT/VF has been detected and in response to therapy being delivered.
  • VT/VF detection may be easier, may require less confirmation, and/or may take a shorter period of time than prior to adjustment of the VT/VF detection parameters.
  • the one or more VT/VF detection parameters must be modified in an opposite fashion than they would be to raise the threshold for detection of VT/VF. Both concepts, raising the threshold and/or lowering the threshold for detection of VT/VF, may be, in other words, modifying the threshold for detection of VT/VF.
  • the method 200 may start an
  • detection of VT/VF (block 204), the delivery of cardiac therapy (block 208), and or the termination of the VT/VF (block 210) may be representative of the amount of time after a sustained VT/VF that a patient is likely to undergo non-sustained VT/VFs.
  • the adjustment time period may be selectable, e.g., by a clinician, such that the adjustment time period may be customized for each individual patient and/or different cardiac conditions.
  • the adjustment time period may be based on previously-monitored heart-related parameters of a patient (e.g., previously-monitored VT VF clusters).
  • the adjustment time period may be about a 1/2 hour to about 24 hours, (e.g., about a 1/2 hour, about 1 hour, about 2 hours, about 4 hours, about 6 hours, about 12 hours, about 24 hours, etc.)
  • the adjustment time period may be maintained until the patient's next visit to a clinician's office for a checkup or the next remote monitoring session (e.g., using Medtronic CARELINK).
  • the adjustment time period may be adjustable by the method 200, e.g., depending on the efficacy of a present or previous adjustment time period.
  • the pressure activity and/or perfusion indicate that the hemodynamic functionality of the patient's heart was compromised (e.g., the hemodynamic functionality of the patient's heart was inadequate) during the adjustment time period, then it may be determined that the adjusted VT/VF detection parameters were unsuccessful and/or ineffective and the VT/VF detection parameters may be reverted to previous VT/VF detection parameters (e.g., VT/VF detection parameters prior to the last automatic adjustment, nominal VT/VF detection parameters, etc.) (block 202).
  • previous VT/VF detection parameters e.g., VT/VF detection parameters prior to the last automatic adjustment, nominal VT/VF detection parameters, etc.
  • the method 300 may receive data indicative of the effectiveness of the adjusted VT/VF detection parameters from an external device via telemetry. If the received data indicates that the patient was stable during the adjustment time period, then the method 300 may deterrnine that the adjusted VT/VF detection parameters were effective and/or successful (block 302) and may proceed to maintaining the adjusted VT/VF detection parameters (block 304).
  • a patient may provide information indicative of the effectiveness of the adjusted VT/VF detection parameters using an external device to the IMD 16. For instance, if the patient did not experience any dizziness, syncope episodes, and/or any other symptoms indicative of at least one heart condition during the adjustment time period, then the patient may transmit data to the IMD 16 that indicates that the adjusted VT/VF detection parameters were effective and or successful. Upon receiving the data, it may be determined that the adjusted VT/VF detection parameters were successful and/or effective (block 302) and the adjusted VT/VF detection parameters may be maintained (block 304). In the alternative, the patient may provide information to the IMD 16 that indicates that the adjusted VT/VF detection parameters were ineffective and/or unsuccessful.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Cardiology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Animal Behavior & Ethology (AREA)
  • Biophysics (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • General Health & Medical Sciences (AREA)
  • Pathology (AREA)
  • Surgery (AREA)
  • Molecular Biology (AREA)
  • Medical Informatics (AREA)
  • Physics & Mathematics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Radiology & Medical Imaging (AREA)
  • Electrotherapy Devices (AREA)

Abstract

La présente invention concerne des procédés et/ou des dispositifs permettant de lancer un ajustement automatique des paramètres de détection de l'arythmie, notamment lors de l'administration d'un traitement cardiaque après détection de tachycardie ventriculaire ou de fibrillation ventriculaire.
PCT/US2011/034474 2010-10-29 2011-04-29 Ajustement automatique des paramètres de détection de l'arythmie Ceased WO2012057865A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US12/915,877 US20120109240A1 (en) 2010-10-29 2010-10-29 Automatic adjustment of arrhythmia detection parameters
US12/915,877 2010-10-29

Publications (2)

Publication Number Publication Date
WO2012057865A1 true WO2012057865A1 (fr) 2012-05-03
WO2012057865A8 WO2012057865A8 (fr) 2013-04-25

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PCT/US2011/034474 Ceased WO2012057865A1 (fr) 2010-10-29 2011-04-29 Ajustement automatique des paramètres de détection de l'arythmie

Country Status (2)

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US (1) US20120109240A1 (fr)
WO (1) WO2012057865A1 (fr)

Families Citing this family (15)

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US9058741B2 (en) 2012-06-29 2015-06-16 Carefusion 207, Inc. Remotely accessing a ventilator
US9177109B2 (en) 2011-11-02 2015-11-03 Carefusion 207, Inc. Healthcare facility ventilation management
US9687618B2 (en) 2011-11-02 2017-06-27 Carefusion 207, Inc. Ventilation harm index
US9821129B2 (en) 2011-11-02 2017-11-21 Vyaire Medical Capital Llc Ventilation management system
US9072849B2 (en) 2012-06-29 2015-07-07 Carefusion 207, Inc. Modifying ventilator operation based on patient orientation
US9737676B2 (en) 2011-11-02 2017-08-22 Vyaire Medical Capital Llc Ventilation system
US20130110924A1 (en) * 2011-11-02 2013-05-02 Tom Steinhauer Wide area ventilation management
US9352110B2 (en) 2012-06-29 2016-05-31 Carefusion 207, Inc. Ventilator suction management
US9327090B2 (en) 2012-06-29 2016-05-03 Carefusion 303, Inc. Respiratory knowledge portal
CN104685680A (zh) * 2012-09-27 2015-06-03 昭和电工株式会社 锂离子二次电池负极用碳材料及其制造方法以及用途
US10252068B2 (en) 2015-11-06 2019-04-09 Medtronic, Inc. Reducing false positive lead integrity alerts
US10252071B2 (en) 2016-04-29 2019-04-09 Medtronic, Inc. Multi-threshold sensing of cardiac electrical signals in an extracardiovascular implantable cardioverter defibrillator
US10675471B2 (en) 2017-08-15 2020-06-09 Medtronic, Inc. Anti-tachycardia pacing control in an implantable medical device system
US10799710B2 (en) 2017-10-23 2020-10-13 Medtronic, Inc. Multi-threshold sensing of cardiac electrical signals in an implantable medical device
US10668290B2 (en) * 2018-03-01 2020-06-02 Medtronic, Inc. Delivery of pacing therapy by a cardiac pacing device

Citations (10)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5117824A (en) 1990-11-14 1992-06-02 Medtronic, Inc. Apparatus for monitoring electrical physiologic signals
US5545186A (en) 1995-03-30 1996-08-13 Medtronic, Inc. Prioritized rule based method and apparatus for diagnosis and treatment of arrhythmias
US5987356A (en) * 1997-06-05 1999-11-16 Medtronic, Inc. Method and apparatus for diagnosis and treatment of arrhythmias
US6067473A (en) 1998-04-29 2000-05-23 Medtronic, Inc. Implantable medical device using audible sound communication to provide warnings
US6393316B1 (en) 1999-05-12 2002-05-21 Medtronic, Inc. Method and apparatus for detection and treatment of cardiac arrhythmias
US20040064062A1 (en) * 2002-09-30 2004-04-01 Xiaohong Zhou Method for determining a metric of non-sustained arrhythmia occurrence for use in arrhythmia prediction and automatic adjustment of arrhythmia detection parameters
WO2006039694A2 (fr) * 2004-09-30 2006-04-13 Cardiac Pacemakers, Inc. Classification d'arythmie et selection de traitement
US20080172098A1 (en) * 2003-04-18 2008-07-17 Gunderson Bruce D Method and apparatus for reducing inappropriate detection of lead-related noise
US20090326356A1 (en) 2008-06-30 2009-12-31 Medtronic, Inc. Cardiac signal sensor control
US20100241180A1 (en) * 2009-03-23 2010-09-23 Whitman Teresa A Combined hemodynamic and egm-based arrhythmia detection

Patent Citations (10)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5117824A (en) 1990-11-14 1992-06-02 Medtronic, Inc. Apparatus for monitoring electrical physiologic signals
US5545186A (en) 1995-03-30 1996-08-13 Medtronic, Inc. Prioritized rule based method and apparatus for diagnosis and treatment of arrhythmias
US5987356A (en) * 1997-06-05 1999-11-16 Medtronic, Inc. Method and apparatus for diagnosis and treatment of arrhythmias
US6067473A (en) 1998-04-29 2000-05-23 Medtronic, Inc. Implantable medical device using audible sound communication to provide warnings
US6393316B1 (en) 1999-05-12 2002-05-21 Medtronic, Inc. Method and apparatus for detection and treatment of cardiac arrhythmias
US20040064062A1 (en) * 2002-09-30 2004-04-01 Xiaohong Zhou Method for determining a metric of non-sustained arrhythmia occurrence for use in arrhythmia prediction and automatic adjustment of arrhythmia detection parameters
US20080172098A1 (en) * 2003-04-18 2008-07-17 Gunderson Bruce D Method and apparatus for reducing inappropriate detection of lead-related noise
WO2006039694A2 (fr) * 2004-09-30 2006-04-13 Cardiac Pacemakers, Inc. Classification d'arythmie et selection de traitement
US20090326356A1 (en) 2008-06-30 2009-12-31 Medtronic, Inc. Cardiac signal sensor control
US20100241180A1 (en) * 2009-03-23 2010-09-23 Whitman Teresa A Combined hemodynamic and egm-based arrhythmia detection

Also Published As

Publication number Publication date
US20120109240A1 (en) 2012-05-03
WO2012057865A8 (fr) 2013-04-25

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